CT Scans That Include the Adrenal Glands
A chest CT scan routinely includes the adrenal glands when the scan field extends through the upper abdomen, which is the standard approach recommended for lung cancer surveillance and staging. 1, 2
Standard Chest CT Coverage
- Chest CT with IV contrast is the primary imaging modality that includes the adrenal glands, particularly when performed for lung cancer surveillance or staging 1, 2
- The American College of Radiology recommends that chest CT scans include the adrenal glands, especially when the scan range extends to the upper abdomen 2
- When chest CT does not automatically include abdominal imaging, the scan range should be extended to cover the adrenal gland area 2
Clinical Context: Lung Cancer Surveillance
- For patients with stage I-III non-small cell lung cancer (NSCLC) treated with curative intent, both NCCN and ASCO guidelines recommend diagnostic chest CT including the adrenal glands (preferably with IV contrast) 1, 2
- There is no evidence of added benefit for a separate CT abdomen and pelvis over a chest CT through the adrenals as a surveillance imaging modality 1
- For small cell lung cancer (SCLC), chest CT including the adrenals is recommended every 2-6 months, as the liver and adrenal glands are the most common sites of hematogenous metastasis 1, 3
Alternative Imaging Options
- CT abdomen without contrast is highly appropriate (rating 8/9) for direct adrenal gland evaluation when an incidental adrenal mass is discovered 1
- Non-enhanced chest CT is usually more accurate than enhanced chest CT for characterizing adrenal nodules, particularly for detecting lipid-rich adenomas 2
- CT chest, abdomen, and pelvis (with or without contrast) can be performed but is not superior to chest CT through the adrenals for routine surveillance 1
Key Clinical Pitfall
The most common error is ordering separate abdominal/pelvic CT when a properly performed chest CT already includes adequate adrenal visualization - this exposes patients to unnecessary radiation and cost without improving detection of metastases or recurrence 1, 2